HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED' FOR APPLICATION TO BE ACCEPTED .
Date:
j�=? •• Permit Number: 0
SC N E®
RECEIVED
y_ Building Permit Application MAR 0 5 ` 7'
Planning and Development Services ST. Lucie County. etzrmlt ing
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential +�
PERMIT APPLICATION, FOR:.
PROPPENT MEAN
33
Legal Description:
oTLr—
ropeft TaG 0,0 - 2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: i Right Side: b i/ D 1' Left Side:
1 Se I 1 a -*X ST d S;7"7"1-4o 9 v P? d<Ia0C1'•e.T�e
i
—Mechanical — Gas Tank Gas Piping
— Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
— Shutters
— Generator
Sq. Ft. of First Floor:
«ons ,ru-c rton: 161epd Utilities: Sewer
`Windows/Doors
Roof Pitch
Septic Building Height:
VNameC�NTRACT(+3
67' e- V -4P_ •�/
Name:
Address: (33 /LD7-t_aE,127 S77"1
Company:
Address:
ity: Kc •e. State: �1.
Zip Code: Fax:
City: State:
Phone No. 7 72 — 7 1G S `7
Zip Code: Fax:
E-Mail:
Phone No
ill in fee simple Title Holder page (jif different
E-Mail
"Irom the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPP � �N � CQ ST�U IC?N
iy, LA I�
F� IVI TIN:
DESIGNER/ENGINEER: - " _ Not Applicable ,
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
_
Address: ' '
City: State: I
Zip: Phone I
FEE SIMPLE.TITLE-HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granti
which is in conflict with any applicable Home Owners A
structure. Please consult with your Home Owners Asso
In consideration of the granting of this requested perm
in accordance with the approved plans, the Florida Buil
The following building permit applications are exempt 1
accessory structures, swimming pools, fences, walls, sib
WARNING TO OWNER: Your failure to Record a
improvements to your property. A Notice of C
before the first inspection. If you intend to ob
commencing work or recording vour Notice of
J i. J
Signature of Own Le
STATE OF FLORIDA
COUNTY OF
ntractor as Agent for
The forgoing instrument w s acknowledge before
this � day of 20- D by
(Name of person ackn
g a permit will authorize the permit holder to build the subject structure
sociation rules, bylaws or and covenants that may restrict or prohibit such
ation and review your deed for any restrictions which may apply.
, I do hereby agree that I will, in all respects, perform the work
ing Codes and St. Lucie County Amendments.
om undergoing a full concurrency review: room additions,
1s, screen rooms and accessory uses to another non-residential use
Notice of Commencement may result in your paying twice for
)mmencement must be recorded and posted on the jobsite
ain financing, consult with lender or an attorney before
Commencement.
er
(Signatu a of Notary Public- State'of Florida )
Personally Known OR Produced Identification
Type of Identificati n
Produced _
KAREN SI NIELSEI
aa```PpT i �.
Commission No. :_° (SBat missionI# FF 1156
- as My Commission [xpir
June 12, 2018
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Rx..Rduced
No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED